In today’s competitive healthcare environment, effective program differentiation is a significant challenge. And, as many hospitals begin to realize the effects of healthcare reform and prepare for further changes in the years to come, achieving a competitive edge — and maintaining it — isn’t easy.
At Corazon, we often assist our clients with a very detailed approach for facing this complex issue through market development and outreach strategies. This process often involves every single component of a program offering any level of cardiovascular services, impacting everyone involved, from the bedside caregiver to specialty physicians, to hospital leadership in the C-suite. We believe, however, that the benefits of implementation are well worth the effort.
For example, something as basic as the size of the cardiologist practice can affect not only volume, but efficiency of patient throughput as well. This, in turn, affects the program volumes (cath, percutaneous coronary intervention [PCI], heart surgery, etc.) realized by the hospital. We also know that the number and configuration of critical care and telemetry beds can affect volume, along with the efficiency of care delivery. Divert status or a telemetry bed ‘bottleneck’ may direct or redirect patients away from the program, negatively affecting volume.
The issue of access to the care delivery process is of paramount importance, especially as hospital leaders consider market development and outreach strategies that would most benefit their cardiovascular program. Programs must be able to demonstrate quality and every ‘door’ to the organization must provide easy access to consumers and physicians alike.
Market and outreach strategies should be understood and evaluated by administrative and physician leadership in the context of patient volume and overall business development strategies: for the organization at large and for the cardiovascular service line in particular. Corazon’s approach to a market assessment involves many steps and can serve as a pragmatic guide for program growth and expansion — a playbook of sorts.
Step #1: Assessing Your Market
There are many key objectives to consider when facilitating a market assessment. First, a thorough understanding of the market dynamics is in order. A cardiovascular-specific market assessment must be performed to gain not only an understanding of the quantifiable aspects of the market, but also the psychographic nature of the area. A solid market assessment involves a review of population demographics, disease incidence, socioeconomics, payor profiles, and utilization of advanced procedures, as well as current and historical volume trends. These are just a few of the variables that encompass a meaningful assessment.
In addition, an in-depth analysis of patient referral patterns, physician practice patterns as related to case selection and judgment, and political forces can add additional detail to the assessment. Understanding the factors impacting the level of business that a program currently owns allows for a test of market dynamics against baseline variables, which can help better predict what the future may hold.
Consider a hospital faced with the decision to close their heart surgery program due to low volumes. Based on population and volume potential, they should have been achieving greater market capture, leading to a greater number of cases. A higher volume threshold would obviously affect efficiency, quality, and program perception (in the mind of referring physicians and the public consumer). Through an assessment of the market, this organization discovered that the cardiologists were not engaged in the referral of patients for heart surgery. Their profiles leaned heavily toward intervention, with surgery serving as the alternative for only a few extremely difficult cases. Furthermore, outreach activities were almost non-existent for this program; the outlying populations were large and growing, with no advanced CV program presence to be found. As a result, most of the market was being referred over and around this particular program.
Cardiologists with a broader approach to treatment options were required, along with a greater presence in remote areas — without them, the program was doomed for failure and ultimately shut down. A serious ramification in this particular state (where on-site open heart surgery is required for PCI) was the loss of the facility’s full-service PCI program as well (emergent cases were allowed), further compromising patient access.
Through the findings of this assessment, the primary objective of this program became attracting and/or recruiting additional cardiologists to refer and support the interventional AND surgical program. Efforts were made to impress upon the current cardiologists the need for maintaining local access to PCI capabilities, encouraging them to support this initiative and somehow see more clearly that the surgical program could not continue solely as a backup for PCI. The surgeons likewise needed to make a commitment to complete all appropriate coronary artery bypass graft (CABG) and valve cases in the community hospital setting rather than transfer to a quaternary center. The development of outreach clinics likewise became a priority, with resources directed to this initiative.
Step #2: Evaluating Your Resources
Accompanying the market assessment must be an analysis of resources available in the region and/or in the hospital or program specifically.
Cath Lab Resources. Understanding capacity and its effect on program operations is no doubt one of the major factors in the success or failure of any review. Simply put, the overall capability of an interventional program is directly affected by cardiac catheterization lab capacity, which often can be limited by the overall efficiency of the lab. Typically, we utilize a benchmark of 1,200 to 1,500 catheterization cases annually for one efficient lab, with a diagnostic to interventional ratio of 3 to 1. However, other variables must be considered, such as electrophysiology (EP) case volume that may be performed in a particular facility/lab, peripheral vascular case volume, and pacemakers and/or other device volume, all of which can skew interventional lab efficiency measures due to shared space.
Cardiology Manpower. The ratio of cardiologists to population nationally is about 1 to 16,000 persons (all ages). In most markets, understanding the practice patterns of primary care physicians (PCPs) in the ongoing management of cardiac disease is an important variable to consider when applying this ratio. Corazon experience reveals that cardiologist demand is a local issue; they can be busy when the ratio is as low as 1 to 10,000, depending on the service mix they are providing. In other words, understanding the subspecialties of the cardiologists (non-invasive, interventional, EP, etc.) will assist in making a reasonable judgment as to how many, and what type, are needed.
Nationally, recruiting for cardiologists is becoming increasingly difficult as the need increases with an aging population and continual technology advancements. To alleviate some of the difficulty with cardiologist recruitment, Corazon advocates having an ongoing cardiology recruitment plan and a succession plan for existing cardiology resources. Programs that are successful in their efforts have maintained the philosophy and practice of perpetual recruiting.
Vascular Physician Manpower. The vascular market remains underserved across the country and requires more advanced, trained vascular specialists to effectively address the growing need. This void will likely continue for years into the future. The full spectrum of available vascular physicians, including cardiologists, vascular surgeons, and/or interventional radiologists, should be considered as a solution. Programs that not only recognize this opportunity, but also proactively address a multi-disciplinary approach to care that leverages varied specialists, will no doubt be better positioned for future success.
Other resource components that must be assessed include, but are not limited to, staffing, bed capacity, equipment, and facility design/technology, as well as philosophies of care delivery.
Step #3: Planning Your Outreach
Once a program has successfully “assessed the market,” the next step is to consider outreach strategies that will impact program growth and physician referral/support of the program, based on the results of the assessment. Corazon believes that outreach is the foundation of a successful cardiovascular program. Down the hall from the exam room or cardiac catheterization lab, or 150 miles away in a primary care physician’s office, access to the care delivery system must be formally in place.
Indeed, there are many components of a successful outreach program:
- Well-trained staff dedicated to “run the traps” for patients at risk for cardiovascular disease to assure timely access to care;
- A well-defined communication protocol for both patients and physicians;
- Available patient transportation should it be needed, backed by emergency medical services (EMS) protocols and tight transfer agreements;
- Formalized linkages with PCPs to the cardiologists and hospital;
- Multi-phase point-of-care screening for both cardiac and vascular diseases; and
- Patient and physician education — about the disease process and perhaps more importantly, about how to access the advanced care system.
Beyond facilitation of a market assessment and the implementation of relevant outreach initiatives based on an individual hospital’s situation, our experience reveals that a program must possess a certain degree of savvy regarding market awareness, along with strategic positioning and alliances.
Step #4: Creating Your Marketing Plan
It is often said that “it’s not what you know, but who you know” to gain an edge in business. Nothing could be more valid when it comes to healthcare and cardiovascular marketing. Herein lies the “image” component of marketing a program.
As a first step, the idea of awareness must be clearly understood and addressed through a marketing plan as part of the assessment and outreach strategy. Mere advertising just touches the surface…there are many and varied means to build and maintain awareness of a program in the minds of patients and referring physicians. By itself, advertising will not work to capture the full program potential, regardless of its scope, cost, or message.
Awareness can come in many forms, including patient word-of-mouth, physician referral, business and community organizations and contacts, medical professionals, and of course payors in a local area/region — all of which are necessary for cultivating outreach through a comprehensive marketing approach. The key to awareness is not relying on any one avenue, but rather on many channels also including media, civic organizations, payors, businesses, and any other points of contact patients may encounter.
Positioning is also critical — being at the “right place at the right time.” This involves having a program that is well defined in all respects, ready to change as necessary, expand as necessary, and make adjustments to quality factors and efficiency factors. Responding quickly ahead of the curve essentially means remaining fluid in this turbulent healthcare environment — being the first program in your market to arrive at “the right place.”
Consider our example of the hospital that lost half of its heart surgery and PCI volume, primarily due to critical positioning factors. This program’s capacity of bed space, catheterization labs, physician manpower, and aged facilities had not kept up with competitors. Meanwhile, the regional providers of advanced cardiovascular procedures went from 2 programs to 6 in about 5 years. To make headway after falling so far behind seemed an impossible task.
However, the administrative leadership of the hospital, especially the cardiovascular service line manager and the hospital CEO, initiated a focused and aggressive planning and development action that changed the attitudes of the physicians. This provided a strong sense of confidence in the board and employees, and brought together a group of supporting citizens of the region to obtain the capital needed for updates. Through this effort, a change to the organizational structure of the entire hospital was made, along with various other expansions to the cardiovascular program. Within two short years, the program became the driver of success for the entire hospital. Positioning moves resulted in the program gaining its volume back and growing exponentially beyond its previous benchmarks.
Another major component of the market plan is strategic alliances. This is inclusive of the development of physician alliances that will sustain and grow the program over the long term. A program in a major midwestern city found itself with shrinking market share and volume, all while rapidly losing cardiologists in a very competitive market with about 15 heart surgery programs. The main goal of the marketing strategy was to attract cardiologists and build a large force of specialty physicians to capture market leadership. After intense strategic relationship-building efforts that involved facility and technology expansion, the development of a multi-disciplinary hospital/physician service line management structure, and an aggressive physician relations campaign, the hospital was able to attract a large number of cardiologists to its campus, and a formal strategic alliance evolved through various employment relationships with the hospital. Now the program has the support of the largest contingent of cardiologists and vascular surgeons in the region.
The scope of marketing for cardiovascular services can be daunting. However, through these examples, you have seen varying perspectives on how marketing should be approached, based on Corazon’s experience and observations of successful programs across the country, both large and small.
The cardiovascular disease population numbers greater than 80 million in the United States, which is almost one out of every three people. Statistics show that some 20 to 30% of all patients in hospital ICUs are there due to some form of cardiovascular disease.
One may think, “Why market for this business when it is already prevalent inside the hospital?” The answer is simple: there is a huge difference between caring for the patients with current and prior complications due to cardiovascular diseases and the much larger population at risk for cardiovascular disease. Many patients have what can be considered severe disease that goes undetected until an unfortunate, life-threatening event. It is this challenge that must be planned for in the “marketing” of a cardiovascular program.
Productivity and quality of life, cost control of care delivered and advancements in the diagnosis and treatment of cardiovascular disease can truly make a difference in expectations of living at an advanced age. Cardiovascular disease is not an inevitable outcome of aging. In fact, when programs create effective outreach through the methods described above, patients will be more aware of disease symptoms, feel more comfortable about asking questions, and be more likely to seek treatment. Likewise, primary care physicians will have the tools at their fingertips to communicate information and refer patients as needed…both of which are important when building a successful outreach effort.
Conrad Vernon can be contacted at firstname.lastname@example.org, or by phone at (412) 364-8200.